Physical compatibility of telavancin hydrochloride with select i.v. drugs during simulated Y-site administration

Housman, Seth T.; Tessier, Pamela R.; Nicolau, David P.; Kuti, Joseph L.

doi:10.2146/ajhp100663

Cited by 12 publications

(12 citation statements)

References 6 publications

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“…A pH change of ≥1.0 was set a priori as compared with the time 0 or comparator solution as an indication of physical incompatibility based on several previously published studies. [6][7][8][9]…”

Section: Methodsmentioning

confidence: 99%

Physical Compatibility of Micafungin With Sodium Bicarbonate Hydration Fluids Commonly Used With High-Dose Methotrexate Chemotherapy

et al. 2017

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The purpose of this study was to determine the physical compatibility of micafungin with commonly used concentrations of sodium bicarbonate hydration fluids administered via a Y-site connected to a central venous catheter (Y-site/CVC). Micafungin sodium (evaluated concentration of 1.5 mg/mL) was combined in a 3:1 (vehicle:drug) ratio with the following commonly used hydration vehicles: 40 mEq/L sodium bicarbonate in 5% dextrose in water with ¼ normal saline (40SB-D5W-1/4NS), 75 mEq/L sodium bicarbonate in D5W (75SB-D5W), and 154 mEq/L sodium bicarbonate in D5W (154SB-D5W). A 3:1 ratio was used based on the flow rates (typically 125 mL/m/h for bicarbonate-containing vehicles and 50 mL/h for micafungin) of the corresponding solutions in a clinical setting. Visual observations recorded to determine physical compatibility included visual inspection against different backgrounds (unaided, black, and white). Other physical observations were as follows: odor, evolution of gas, pH, and turbidity immediately recorded after mixing and at specified time points up to 2 hours. Evaluations at each time point were compared against baseline observation values at Time 0. All combinations tested were found to be compatible up to 2 hours. Time points beyond 2 hours cannot be safely verified as compatible. Micafungin may be administered safely using a Y-site/CVC delivery system with all the vehicles tested in this study.

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Section: Methodsmentioning

confidence: 99%

Physical Compatibility of Micafungin With Sodium Bicarbonate Hydration Fluids Commonly Used With High-Dose Methotrexate Chemotherapy

et al. 2017

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“…11 A calibrated laboratory grade pH meter p was used, and incompatibility was defined as a mean absolute change from the initial reading of greater than 1 pH unit over the 4-hour observational period. 10 Both assessments were made immediately after mixing and at 15 minutes, 60 minutes, and 4 hours.…”

Section: Methodsmentioning

confidence: 99%

“…The combined solutions were examined initially with the unaided eye in normal fluorescent light. 10 If at any time during testing combination medications were visually incompatible, testing was halted and incompatibility was recorded. Solutions were then examined using a high-intensity monodirectional light source k (Tyndall beam).…”

Section: Methodsmentioning

confidence: 99%

Simulated Y-Site Compatibility of Vancomycin and Piperacillin-Tazobactam

2015

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Purpose:To evaluate the physical compatibility of vancomycin with piperacillin-tazobactam during simulated Y-site administration. Methods: Vancomycin and piperacillin-tazobactam were tested using 2 different diluents: 0.9% sodium chloride and 5% dextrose for injection. Vancomycin concentrations of 2, 5, and 10 mg/mL were tested using 0.9% sodium chloride and 4 and 8 mg/mL in 5% dextrose. Piperacillin-tazobactam was diluted to 16, 30, 40, 80, and 100 mg/mL, representing common concentrations used clinically in hospitals, and concentrations were tested in both 0.9% sodium chloride and 5% dextrose for injection. Medications were reconstituted under USP <797> aseptic technique. Combinations were tested in duplicate and reverse order with control solutions. Compatibility testing for Y-site included visual inspection, inspection with a high-intensity monodirectional light source (Tyndall beam), turbidimeter for turbidity evaluation, pH, and microscopic viewing. Testing occurred immediately after mixing, 15 minutes, 60 minutes, and 4 hours. If inconsistencies were observed between samples, testing was repeated to confirm results. Solutions were deemed incompatible if any one test failed and compatible if all tests were accepted. Results: When dextrose 5% for injection was used as the diluent, vancomycin 4 mg/mL was Y-site compatible with piperacillin-tazobactam 16, 30, and 40 mg/mL and incompatible with 80 and 100 mg/mL. Vancomycin 8 mg/mL was incompatible with all tested concentrations of piperacillin-tazobactam. When 0.9% sodium chloride was used as the diluents, Y-site compatibility was found with vancomycin 2 and 5 mg/mL and all tested concentrations of piperacillin-tazobactam. Vancomycin 10 mg/mL was incompatible with piperacillin-tazobactam 40, 80, and 100 mg/mL. Incompatibilities formed a white precipitate immediately on mixing. Conclusion: Y-site incompatibility was greater for the tested concentrations of piperacillintazobactam and vancomycin when 5% dextrose was used as the diluent versus 0.9% sodium chloride. Y-site incompatibility was seen immediately in the form of a white precipitate on mixing.

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“…Acetaminophen Direct globule size enlargement and colour changing within one hour of mixing [18] Alfentanil Concentration degradation of the drug within six hours of mixing [45] Amikacin sulphate Precipitation indicated by formation of white sediment immediately after mixing and the occurrence of colour changing from white to yellow [43] Calcium chloride Precipitation indicated by formation of white sediment within one hour of mixing [43] Cefepime Precipitation indicated by formation of sediment within one hour of mixing [41] Diazepam Emulsion damage directly after mixing by the occurrence of oiling out [43] Doripenem Precipitation indicated by the formation of sediment directly after mixing [30] Eravacycline Direct colour changing immediately after mixing and decrease of pH value [33] Fosfomycin Formation of an oil-free layer above the emulsion surface after mixing [37] Gentamicin sulphate Precipitation indicated by formation of white sediment directly after mixing [43] Isavuconazonium sulphate Formation of an oil-free layer above the emulsion surface after mixing [32] Methotrexate Precipitation indicated by formation of white sediment within one hour of mixing [43] Netilmicin sulphate Precipitation indicated by formation of white sediment directly after mixing [43] Nimodipine Coalescence of oil droplets that causes emulsion phase separation after mixing [23] Phenytoin Precipitation indicated by formation of crystalline sediment immediately after mixing [43] Plazomicin Formation of an oil-free layer above the emulsion surface after mixing [31] Remifentanil hydrochloride Fatty globule size enlargement as the result of coalescence and colour changing from white to yellow within 24 hours [24] Formation of aggregate directly after mixing [23] Ringer lactate Precipitation indicated by formation of sediment immediately after mixing [46] Tazobactam-Ceftolozane Formation of an oil-free layer above the emulsion surface after mixing and change of pH value [42] Telavancin Formation of an oil-free layer above the emulsion surface after mixing [39] Tobramycin sulphate Precipitation indicated by formation of white sediment directly after mixing [43] Vancomycin Precipitation indicated by formation of sediment within one hour of mixing [40]…”

Section: Table 3 Occurrence Of Incompatibility Of Propofol Mixed Witmentioning

confidence: 99%

Systematic review of the stability and compatibility of propofol injection

Husna¹,

Munawiroh²,

Ekawati³

et al. 2021

ait

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The most popular intravenous general anaesthesia for both induction and maintenance for almost every surgery is propofol [1]. Propofol has several advantages, such as a fast onset of 15-20 seconds, minimal post-operative nausea and vomiting, and a short recovery time of 2-10 minutes [2]. Propofol also has some side effects, such as soreness at the time of injection and hypotension [3]. Propofol is formulated as an emulsion that has a milky white colour and a rather thick texture; it has a pH of 7 to 8.5 and has high solubility in oil (i.e., lipophilic) [4]. Propofol is formulated as a macroemulsion with soybean oil (100 mg mL-1), lecithin (12 mg mL-1), and glycerol (22.5 mg mL-1) that can easily become unstable [5]. Propofol is available as 1% and 2% concentrations in emulsions. Propofol 1% in a vial consists of 200 mg of the drug (10 mg mL-1 in a volume of 20 mL) [6]. Meanwhile, the dosage of propofol needed for anaesthesia induction is 1.5-2.5 mg kg-1 of body mass; thus, in general, an adult patient only needs 75-125 mg, meaning that one vial can be used for 2-3 patients [7]. Therefore, in daily practice, propofol emulsion is often divided into preparations and is stored for more than 24 hours, which may alter the stability of the original formula. In addition, propofol is often administered along with other IV drugs through the same line, which can induce incompa tibility.

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Physical compatibility of telavancin hydrochloride with select i.v. drugs during simulated Y-site administration

Cited by 12 publications

References 6 publications

Physical Compatibility of Micafungin With Sodium Bicarbonate Hydration Fluids Commonly Used With High-Dose Methotrexate Chemotherapy

Physical Compatibility of Micafungin With Sodium Bicarbonate Hydration Fluids Commonly Used With High-Dose Methotrexate Chemotherapy

Simulated Y-Site Compatibility of Vancomycin and Piperacillin-Tazobactam

Systematic review of the stability and compatibility of propofol injection

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